Managaing Maternal Hemorrhage Poster - New York State

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					Managing
Maternal Hem rrhage                                                            Important Phone Numbers
Vital Signs
Normal vitals do not always assure patient stability
• Airway–intubate
    Provide adequate ventilation
    Assist airway protection
• Breathing
    Supplemental O2 5-7 L/min by tight face mask to assist O2 carrying
    capacity
• Circulation
    Pallor, delayed capillary refill and decreased urine output can indicate
    compromised blood volume without change in BP or HR
    Decreased urine output, decreased BP and tachycardia may be late signs
    of compromise

Infusions
• Start 2nd large bore (16 gauge or larger)
• RL or NS replaces blood loss at 3:1
• Volume expanders 1:1 (albumin, hetastarch, dextran)
• Transfusion
• Coagulation factors
• Warm blood products and infusions to prevent hypothermia,
   coagulopathy and arrhythmias

Medication for uterine atony
• Oxytocin
    10-40 units in 1 liter NS or RL IV rapid infusion
    *30-40 units/liter most commonly used dose for hemorrhage
• Methylergonovine (Methergine)
    0.2 milligrams intramuscular q 2-4 hrs up to 5 doses
    avoid with hypertension
• Prostaglandin F2 Alpha (Hemabate)
    250 micrograms intramuscular, intramyometrial, repeat q 20-90 minutes,                                                 O B S TE T R I C I
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    maximum 8 doses                                                                                         EG
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    avoid with asthma or hypertension
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• Prostaglandin E2 suppositories (Dinoprostone, Prostin E2)                                                1951
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    20 milligrams per rectum q 2 hrs
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    avoid with hypotension                                                                                      'S
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• Misoprostol (Cytotec)                                                            The American College
    1000 micrograms per rectum or sublingual (ten 100 microgram tabs or              of Obstetricians
    five 200 microgram tabs)                                                        and Gynecologists

Surgical Interventions                                                                   Adapted from material
                                                                                               developed by the
    May be a life-saving measure and should not be delayed                            New York City Department
                                                                                  of Health and Mental Hygiene